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Home My WebLink About000146.tiff 1 7% _ _/ z7 a"'A gThe Travelers Indemnity Compost I.- '1,„ 'L" Policy Jacket— ;,° Edition July 1, 1966 HOPKINS-LUNDY INSURORS, INC en closed nclosed Declarations en om and 2001st Nat'l Bank Bldg.,353-5536 x`oVefOge Parts GREELEY COLORADO I'stet (plus any endorsements) r eta complete your -•- WJ policy. Alolicy Title �� `Y Named Insured y" and Address: A Policy Period: • _ y y yr� yt ye y 9• @1 "Bj nGc' 91 61 NC— Fh 1 I' • .�0 �4 eB 1 �/ �4� Y9 ea� 9. a•1 ?'9 e�� ?y The Travelers Indemnity Company Hartford, Connecticut (A Stock Insurance Company, Herein Called The Company) In consideration of the payment of the premium, in reliance upon the statements in the declarations made a part hereof and subject to all of the terms of this policy, agrees with the named insured as follows: Definitions When used in this policy (including endorsements forming a part hereof): • "elevator" means any hoisting or lowering device to connect floors or "automobile"means a land motor vehicle,trailer or semi-trailer designed landings, whether or not in service, and all appliances thereof including for travel on public roads(including any machinery or apparatus attached any car, platform, shaft, hoistway, stairway, runway, power equipment thereto), but does not include mobile equipment; and machinery; but does not include an automobile servicing hoist, or a hoist without a platform outside a building if without mechanical power "bodily injury" means bodily injury, sickness or disease sustained by or if not attached to building walls, or a hod or material hoist used in or alteration,construction or demolition operations,or an inclined conveyor any person; P Y used exclusively for carrying property or a dumbwaiter used exclusively "completed operations hazard" includes bodily injury and property for carrying property and having a compartment height not exceeding damage arising out of operations or reliance upon a representation or four-feet; warranty made at any time with respect thereto, but only if the bodily "incidental contract" means any written I lease of injury or property damage occurs after such operations have been com- ( ) premises, (2) ease- injury or abandoned and occurs away from premises owned by or rented merit agreement, except in connection with construction or demolition to the named insured. "Operations"include materials,parts or equipment operations on or adjacent to a railroad, (3) undertaking to indemnify a furnished in connection therewith.Operations shall be deemed completed municipality required by municipal ordinance,except in connection with at the earliest of the following times: work for the municipality, (4) sidetrack agreement, or(5) elevator main- (1) when all operations to he performed by or on behalf of the named tenance agreement; insured under the contract have been completed, "insured" means any person or organization qualifying as an insured in (2) when all operations to be performed by or on behalf of the named the "Persons Insured" provision of the applicable insurance coverage, insured at the site of the operations have been completed, or The insurance afforded applies separately to each insured against whom (3) when the portion of the work out of which the injury or damage claim is made or suit is brought, except with respect to the limits of the arises has been put to its intended use by any person or organization company's liability; other than another contractor or subcontractor engaged in perform- ing operations for a principal as a part of the same project. "mobile equipment" means a land vehicle (including any machinery or apparatus attached thereto), whether or not self-propelled, (1) not sub- Operations which may require further service or maintenance work, or ject to motor vehicle registration, or (2) maintained for use exclusively correction, repair or replacement because of any defect or deficiency, but on premises owned by or rented to the named insured,including the ways which are otherwise complete, shall he deemed completed. immediately adjoining, or (3) designed for use principally off public roads, or (4) designed or maintained for the sole purpose of affording The completed operations hazard does not include bodily injury or property mobility to equipment of the following types forming an integral part of damage arising out of or permanently attached to such vehicle: power cranes, shovels, loaders, (a) operations in connection with the transportation of property, unless diggers and drills; concrete mixers (other than the mix-in-transit type); the bodily injury or property damage arises out of a condition in or graders,scrapers,rollers and other road construction or repair equipment; on a vehicle created by the loading or unloading thereof, air-compressors, pumps and generators, including spraying, welding and (b) the existence of tools, uninstalled equipment or abandoned or unused building cleaning equipment; and geophysical exploration and well materials, or servicing equipment; (c) operations for which the classification stated in the policy or in the "named insured" means the person or organization named in Item 1. of company's manual specifies "including completed operations"; the declarations of this policy; "damages" includes damages for death and for care and loss of services "named insured's products" means goods or products manufactured, resulting from bodily injury and damages for loss of use of property sold, handled or distributed by the named insured or by others trading resulting from property damage; under his name, including any container thereof (other than a vehirleL (—A i. -' Page 1 146 Page 2 but "named insured's products" shall not include a vending machine or (3) anywhere in the world with respect to damages because of bodily any property other than such container, rented to or located for use of injury or property damage arising out of a product which was sold others but not sold; for use or consumption within the territory described in paragraph (1) above, provided the original suit for such damages is brought "occurrence" means an accident, including injurious exposure to condi- tions, which results,during the policy period, in bodily injury or property within such territory; damage neither expected nor intended from the standpoint of the insured; "products hazard" includes bodily injury and property damage arising "policy territory" means: out of the named insured's products or reliance upon a representation or (1) the United States of America,its territories or possessions,or Canada, warranty made at any time with respect thereto, but only if the bodily or injury or property damage occurs away from premises owned by or rented to the named insured and after physical possession of such products has (2) international waters or air space, provided the bodily injury or been relinquished to others; property damage does not occur in the course of travel or transporta- tion to or from any other country, state or nation, or ♦ "property damage" means injury to or destruction of tangible property. Supplementary Payments The company will pay, in addition to the applicable limit of liability: ♦ of bail bonds required of the insured because of accident or traffic law (a) all expenses incurred by the company, all costs taxed against the violation arising out of the use of any vehicle to which this policy insured in any suit defended by the company and all interest on the applies,not to exceed$250 per bail bond,but the company shall have entire amount of any judgment therein which accrues after entry of no obligation to apply for or furnish any such bonds; the judgment and before the company has paid or tendered or de- (c) expenses incurred by the insured for first aid to others at the time of posited in court that part of the judgment which does not exceed the an accident, for bodily injury to which this policy applies; limit of the company s liability thereon; (d) reasonable expenses incurred by the insured at the company's re- (b) premiums on appeal bonds required in any such suit, premiums on quest, including actual loss of wages or salary (but not loss of other bonds to release attachments in any such suit for an amount not in income) not to exceed $25 per day because of his attendance at excess of the applicable limit of liability of this policy,and the cost ♦ hearings or trials at such request. Nuclear Energy Liability Exclusion (Broad Form) I. The policy does not apply: ♦ "nuclear material"means source material,special nuclear material cc A. Under any Liability Coverage, to bodily injury or property damage byproduct material; (1) with respect to which an insured under the policy is also an "source material", "special nuclear material", and "byproduct insured under a nuclear energy liability policy issued by material" have the meanings given them in the Atomic Energy Act Nuclear Energy Liability Insurance Association, Mutual of 1954 or in any law amendatory thereof; Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada,or would be an insured under any such "spent fuel" means any fuel element or fuel component, solid or policy but for its termination upon exhaustion of its limit of liquid, which has been used or exposed to radiation in a nuclear liability; or reactor; (2) resulting from the hazardous properties of nuclear material "waste"means any waste material(1)containing byproduct material and with respect to which (a) any person or organization is and (2)resulting from the operation by any person or organization required to maintain financial protection pursuant to the of any nuclear facility included within the definition of nuclear Atomic Energy Act of 1954, or any law amendatory thereof, facility under paragraph(a)or(b)thereof; or (b) the insured is, or had this policy not been issued would be, entitled to indemnity from the United States of America, "nuclear facility" means or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof,with any (a) any nuclear reactor, person or organization. (b) any equipment or device designed or used for(1)separating the B. Under any Medical Payments Coverage, or under any Supple- isotopes of uranium or plutonium, (2) processing or utilizing mentary Payments provision relating to first aid, to expenses in- spent fuel, or(3) handling, processing or packaging waste, curred with respect to bodily injury resulting from the hazardous (c) any equipment or device used for the processing, fabricating properties of nuclear material and arising out of the operation of a or alloying of special nuclear material if at any time the total nuclear facility by any person or organization. amount of such material in the custody of the insured at the C. Under any Liability Coverage, to bodily injury or property damage premises where such equipment or device is located consists of resulting from the hazardous properties of nuclear material,if or contains more than 25 grams of plutonium or uranium 233 (1) the nuclear material(a) is-at any nuclear facility owned yy, or or any combination thereof,or more than 250 grams of uranium operated by or on behalf of, an insured or (b) has been die- 235, charged or dispersed therefrom; (d) any structure, basin, excavation, premises or place prepared ar (2) the nuclear material is contained in spent fuel or waste at any used for the storage or disposal of waste, time-possessed, handled, used, processed, stored, transported and includes the site on which any of the foregoing is located, all or disposed of by or on behalf of an insured;or operations conducted on such site and all premises used for such (3) the bodily injury or properly damage arises out of the furnishing operations; by an insured of services, materials, parts or equipment in "nuclear reactor"means any apparatus designed or used to sustain connection with the planning, construction, maintenance, nuclear fission in a self-supporting chain reaction or to contain a operation or use of any nuclear facility, but if such facility is critical mass of fissionable material; located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to "property damage"includes all forms of radioactive contamination property damage to such nuclear facility and any property of property. thereat. II. As used in this exclusion: III. This exclusion modifies the provisions of the policy relating to all Automobile Liability, General Liability and Medical Payments "hazardous properties" include radioactive, toxic or explosive Insurance other than Comprehensive Personal and Farmer's Com- properties; ♦ prehensive Personal Insurance. Conditions 1. Premium. All premiums for this policy shall be computed in accord- • 6. Other Insurance. The insurance afforded by this policy is primary ance with the company's rules, rates, rating plans, premiums and insurance,except when stated to apply in excess of or contingent upon minimum premiums applicable to the insurance afforded herein. the absence of other insurance.When this insurance is primary and the Premium designated in this policy as "advance premium" is a deposit insured has other insurance which is stated to be applicable to the loos premium only which shall be credited to the amount of the earned on an excess or contingent basis, the amount of the company's liability premium due at the end of the policy period.At the close of each period under this policy shall not be reduced by the existence of such other (or part thereof terminating with the end of the policy period) desig- insurance. nated in the declarations as the audit period the earned premium shall When both this insurance and other insurance apply to the loss on the be computed for such period and, upon notice thereof to the named same basis, whether primary, excess or contingent, the company shall insured,shall become due and payable. If the total earned premium for not be liable under this policy for a greater proportion of the loss than the policy period is less than the premium previously paid, the com- that stated in the applicable contribution provision below: pany shall return to the named insured the unearned portion paid by (a) Contribution by Equal Shares. If all of such other valid and the named insured. collectible insurance provides for contribution by equal shares, the The named insaeed shall maintain records of such information as is company shall not be liable for a greater proportion of such kiss necessary for premium computation, and shall send copies of such than would be payable if each insurer contributes an equal share records to the company at the end of the policy period and at such until the share of each insurer equals the lowest applicable limit times during the policy period as the company may direct. of liability under any one policy or the full amount of the loss is paid, and with respect to any amount of loss not so paid the 2. Inspection and Audit. The company shall be permitted but not ob- remaining insurers then continue to contribute equal shares of the ligated to inspect the named insured's property and operations at any remaining amount of the loss until each such insurer has paid its time. Neither the company's right to make inspections nor the making limit in full or the full amount of the loss is paid. thereof nor any report thereon shall constitute an undertaking, on (b) Contribution by Limits. If any of such other insurance does not behalf of or for the benefit of the named insured or others,to determine provide for contribution by equal shares, the company shall not or warrant that such property or operations are safe. be liable for a greater proportion of such loss than the applicable The company may examine and audit the named insured's books and limit of liability under this policy for such loss bears to the total records at any time during the policy period and extensions thereof and applicable limit of liability of all valid and collectible insurance within three years after the final termination of this policy, as far as against such loss. they relate to the subject matter of this insurance. 7. Subrogation. In the event of any y payment under this policy, the 3. Financial Responsibility Laws. When this policy is certified as proof company shall be subrogated to all the insured's rights of recovery of financial responsibility for the future under the provisions of any therefor against any person or organization and the insured shall motor vehicle financial responsibility law,such insurance as is afforded execute and deliver instruments and papers and do whatever else is by this policy for bodily injury liability or for property damage liability necessary to secure such rights.The insured shall do nothing after loss shall comply with the provisions of such law to the extent of the cover- to prejudice such rights. age and limits of liability required by such law. The insured agrees to reimburse the company for any payment made by the company which 8. Changes. Notice to any agent or knowledge possessed by any agent it would not have been obligated to make under the terms of this or by any other person shall not effect a waiver or a change in any part policy except for the agreement contained in this paragraph. of this policy or estop the company from asserting any right under the terms of this policy; nor shall the terms of this policy be waived or 4. Insured's Duties in the Event of Occurrence, Claim or Suit. changed, except by endorsement issued to form a part of this policy, (a) In the event of an occurrence,written notice containing particulars signed by the President, a Vice President, Secretary or Assistant sufficient to identify the insured and also reasonably obtainable Secretary of the company; provided, however, changes may be made information with respect to the time, place and circumstances in the written portion the declarations by a manager general agent of the company when initialed by such manager or general agent. thereof,and the names and addresses of the injured and of available witnesses, shall be given by or for the insured to the company or 9, Assignment. Assignment of interest under this policy shall not bind any of its authorized agents as soon as practicable. The named the company until its consent is endorsed hereon; if, however, the insured shall promptly take at his expense all reasonable steps to named insured shall die, such insurance as is afforded by this policy prevent other bodily injury or property damage from arising out of ! shall apply the same or similar conditions, but such expense shall not be re- pn u (1) to the named insured's' legal representative, as the coverable under this policy. named s insured, but only while acting within the his e ,duties o as such, and (2)with respect to the property of the named insured, to (b) If claim is made or suit is brought against the insured, the insured the person having proper temporary custody thereof, as insured, but shall immediately forward to the company every demand, notice, only until the appointment and qualification of the legal representative. summons or other process received by him or his representative. 10. Three Year Policy. If this policy is issued for a period of three years, (c) The insured shall cooperate with the company and, upon the corn- the limits of the company's liability shall apply separately to each pany's request, assist in making settlements, in the conduct of consecutive annual period thereof. suits and in enforcing any right of contribution or indemnity against any person or organization who may be liable to the insured 11. Cancellation. This policy may be canceled by the named insured by' because of bodily injury or property damage with respect to which mailing to the company written notice stating when thereafter the insurance is afforded under this policy;and the insured shall attend cancellation shall be effective. This policy may be canceled by the hearings and trials and assist in securing and giving evidence and company by mailing to the named insured at the address shown in this obtaining the attendance of witnesses. The insured shall not, policy, written notice stating when not less than ten days thereafter except at his own cost,voluntarily make any payment,assume any such cancellation shall be effective. The mailing of notice as aforesaid obligation or incur any expense other than for first aid to others at shall be sufficient proof of notice. The effective date and hour of can- the time of accident. cellation stated in the notice shall become the end of the policy period. Delivery of such written notice either by the named insured or by the S. Action Against Company. No action shall lie against the company company shall be equivalent to mailing. unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount If the named insured cancels, earned premium shall be computed in of the insured's obligation to pay shall have been finally determined accordance with the customary short rate table and procedure. If the either by judgment against the insured after actual trial or by company cancels, earned premium shall be computed pro rata. Pre- written agreement of the insured, the claimant and the company. maim adjustment may be made either at the time cancellation is effected or as soon as practicable after cancellation becomes effective, Any person or organization or the legal representative thereof who has but payment or tender of unearned premium is not a condition of secured such judgment or written agreement shall thereafter be entitled cancellation. to recover under this policy to the extent of the insurance afforded by this policy. No person or organization shall have any right under this 12. Declarations. By acceptance of this policy, the named insured agrees policy to join the company as a party to any action against the insured that the statements in the declarations are his agreements and repre- to determine the insured's liability,nor shall the company be impleaded sentations, that this policy is issued in reliance upon the truth of such by the insured or his legal representative. Bankruptcy or insolvency representations and that this policy embodies all agreements existing of the insured or of the insured's estate shall not relieve the company of ' between himself and the company or any of its agents relating to this any of its obligations hereunder. j insurance. (continued on Page 3) Page 3 New York Special Provision—If a Comprehensive Automobile Liability Insurance, Garage Insurance or Automobile Medical Payments Insurance Cover- age Part forming a part of this policy insures premises located or automobiles principally garaged in New York, the Nuclear Energy Liability Exclusion (Broad Form) does not apply to such premises or automobiles. Puerto Rico Special Provision—It is agreed that the Action Against Company Condition applicable to any liability coverage afforded by the policy with respect to occurrences which take place in Puerto Rico is amended to read: No action shall lie against the company unless as a condition precedent thereto,the insured shall have fully complied with all the terms of this policy. South Carolina Special Provision—If a Comprehensive General Liability, Manufacturers' and Contractors' Liability, Owners', Landlords' and Tenants' Liability, Completed Operations and Products Liability, Contractual Liability, Premises Medical Payments or Garage Insurance Coverage Part forming a part of this policy insures premises located in South Carolina, it is agreed that with respect to such insurance that part of the alcoholic beverage ex- clusion which relates to the selling, serving or giving of any alcoholic beverage (a) to a person under the influence of alcohol or(b)which causes or contributes to the intoxication of any person, is deleted. Vermont Special Provision—If this policy affords a Liability Coverage with respect to a premises located or an automobile principally garaged in Vermont, it is agreed that the policy is amended in the following particulars with respect to such Coverage: The Policy, including this endorsement, is issued and delivered subject to the Laws of Vermont and particularly to Section 9242, Chapter 391 "The Vermont Statutes, Revision of 1947," including the following statutory requirements forming a part of such Laws: The company shall pay and satisfy any judgment that may be recovered against the insured upon any claim covered by this Policy to the extent and within the limits of liability assumed thereby, and shall protect the insured against the levy of any execution issued upon any such judicial judgment or claim against the insured. No limitation of liability in this Policy shall be valid if, after a judgment has been rendered against the insured in respect to his legal liability for damages in a particular instance, the company continues the litigation by an appeal or otherwise, unless the insured shall stipulate with the company, agreeing to continue such litigation. No action shall lie against the company to recover for any loss under this Policy,unless brought within one year after the amount of such loss is made certain either by judgment against the insured after final determination of the litigation or by agreement between the parties with the written consent of the company. The insolvency or bankruptcy of the insured shall not release the company from the payment of damages for injury sustained or loss occasioned during the life of the Policy,and in case of such insolvency or bankruptcy an action may be maintained by the injured person or claimant against the company under the terms of the Policy for the amount of any judgment obtained against the insured not exceeding the limits of the Policy. Payment of any judicial judgment or claim by the insured for any of the company's liability hereunder shall not bar the insured from any action or right of action against the company. In case of payment of loss or expense under this Policy, the company shall be subrogated to all rights of the insured against any party, as respects such loss or expense, to the amount of such payment, and the insured shall execute all papers required and shall cooperate with the company to secure to the company such rights. In witness whereof,THE TRAVELERS INDEMNITY COMPANY has caused this policy to be signed by its President and Secretary at Hartford, � te ��andd countersigned on the declarations page by a duly authorized agent of the company. EE Secretary President C-11113 Edition July 1,1966 PRINTED IN U.S.A. N.S. (GA) The Travelers Indemnity Company Hartford, Connecticut Policy Number lI,sL 2 37 3 6 7 3 illPh64 DECLARATIONS COMPREHENSIVE AUTOMOBILE—GENERAL LIABILITY POLICY Item 1. Named Insured THE BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WELD Address (No.,street,town,county,state) 9`1f • 9TH AVENUE GREELEY, W LD CO.-, COLORADO 80631 -.___ _ item 2. Policy Period: FromJAN 15, 1949 to JAN 15, 1970 12:01 A.M.t Item 3. Limits of Liability Advance Coverages each each Premium Parts erson o c r ence a e ate Comprehensive Bodily Injury Liability j300 M 500 M 5D0 M s 34}12 L..1 General Property Damage Liability 100 M 300 M$ 9 Comprehensive Bodily Injury Liability 300 M A1r. $ L-2A Automobile Property Damage Liability J _ $ i Contractual Bodily Injury Liability _ M M -- $ The insurance afforded is only with respect to such of the Coverage Liability Property Damage Liability M M; - Parts as are indicated by Symbol Premises $ each person Number and the Coverages therein Medical Payments $ M each accident $ as are indicated by specific premium Automobile Medical Payments $ each person $ charge. The limit of the company's Uninsured Motorists $ M each person liability against each such Coverage (Damages for Bodily Injury) $ M each accident $ shall be as stated herein, subject to Comprehensive $ $ all the terms of this policy having Automobile Collision ACV Less$SGH Deductible $ 1183 reference thereto. In any Limits of L-16 Physical Fire, Lightning or Transportation $ ion Damage Theft $SEE SCHEDULE $ I NCE Liability space the letter "M" means "Thousands of Dollars" and Combined Additional the letters "ACV" mean "Actual L•22 HOSPITAL PROFESSIONAL $ 168 Cash Value". $ Symbol numbers of Schedules,Endorsements, and additional Coverage Parts forming a ; 11 P 937 part of this policy on its effective date. SEE END. 9380 Total Advance Premium Item 4. (a) The named insured is: individual ❑; partnership El; corporation ❑; joint venture ❑; other:COUNTY (b) Audit Period: Annual, unless otherwise stated; semi-annual ❑; quarterly ❑; monthly ❑ Item 5. During the past three years no insurer has canceled insurance,issued to the named insured,similar to that afforded hereunder,unless otherwise stated herein: General Liability Coverage Parts—The declarations are completed on an accompanying schedule designated "General Liability Hazards". Automobile Liability Coverage Parts—The declarations are completed on an accompanying schedule designated "Automobile Liability Hazards". #Standard time at the addres the named insured as stated herein. 1, i Countersigned c Keep this declarations page in your "Policy Jacket—Edition July 1, 1966", Form C-11113. These declarations-and all Coverage Parts, Schedules and Endorsements issued to form a part hereof, together with your Policy Jacket, form your complete insurance policy. c-11115 Edition July 1, 1966 PRINTED IN U.S.A. 1266 ]SYMBOL NUMBERS OF ENDORSEMENTS Amending Policy No. NSL. 23�71 3678 It is agreed that endorsements with the following symbol numbers form a part of this policy on its effective date: te 6210A 6614 8810 333 6309 0 8890 6610 880© A) 9300 THE TRAVELERS INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY ��y/APC Secretary Secretary Secretary 9380 C-10925 1-66 PRINTED IN U.S.A. This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: AUTOMOBILE PHYSICAL DAMAGE INSURANCE LIMITATION OF USE — COMMERCIAL (Not applicable in Puerto Rico) It is agreed that, with respect to any covered automobile which is designated herein or in the declarations as subject to this endorsement, no regular or frequent trips are or will he made during the policy period to any location beyond a 50 mile radius from the limits of the city or town wherein such covered automobile is principally garaged, unless otherwise stated herein. Covered Automobile(s) to which Applicable Radius (no. of Miles), this endorsement applies if other than 50 Miles Amending Policy No. THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY Secretary Secretary ,C-11622 EDITION OCT. 1, 1966 PRINTED IN U.S.A. N.S. GA-39 Effective from at the time of day the policy becomes effective. Amending Policy No. Issued to Date of Issue: OR CODE CODE OFFICE F I PROD• t C _ USE PL. MODE OF IOC.OF ADJUST. I RISK (The information provided for above,except the policy number, is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: If ctt"J-4"S,'ir s'as3avit p: ,,.�^. a � k' std C?'?.,:e. inso 'i"tt`r-;tP 3.w vSf arcade,/ i a of �Le po c relating to th .foii1o?411 1?s :Y• a: 0Cz'4MSt, .A.I DLOFF.t).Sr 71.24/141164 Lx.tr°3 may mistmoc.t r.�u.awaww•-c se.s.+ys' �-�tr•w•..��rvn .e...Mn�Wq .,:,,-.�:.wlwr Ratip��; pv yy��, �•�ti�ry,�q�p� yI}�M�1Y•+�OiY�Qy �My�1, r� r.�,��wp:ar.rs iln.4aAwwv.-... •.. o li.['"iL,}A .4.Yir 42:115 i3.L`A';diri Lll41 Ltij.3.1,11'•2C7 t 1: 'eed that 6110 : ,i e ? p ti eta to the intar i 4,,3t.1ti ono,' r`s:"o'•1stctl8 S ...•.�. s t ,lN"S >~ItA13 Fit: re0 'i E?C l ofho defiltition of .1l i 5:1etu0 pied to r6e6i follomel "ins u ed premises" mews the er le �4e below ��y +e d 'q.�"�"r�— �.i'Y'WuE.�s� '•Y�JIi.k��.sdcralS Y,•�1 �i.+E�.l�` Y'�1��`t lig A eu alb to tf� . a c;. � r; ,t imc],usri4ng the i►`SA ,1� t End including gar -and 0,:eA';)4.1oa inoidentkal thereto, �. thereto rte 1 ''• s r s ,nedarideal toots ^ t l�'�. plots or halal irealt , i .., rika 3e4t to operestytt, at such rr :> ses y (a) the insurance an)lip,- to ' :4: ,>!%ri or propt-c1 c �e arising oat, o the s rtbot'tt�°� i{ ; �a�r�� l« ,? a: c1 's 'R.., ,� „ of o ilt•ter' ag biti:UillgS or other ettrtieti , airs. ,convt ton o .eb"rol3.�.�.r perfonsed b' or oz. b if of the 4s � isx oe x�'ions, egaz'�z-�:feu or ,� ��. t�'f.o� letx�lx a�.�;��..3. � col tz opeTi4iime‘Kro Yoz' tha I.A..,rpose A3` eheng,..i.,as VAG use of the ineurveci tremeisee to o, r-• than ingolut-stro urn faldUY rblea !i 4�• +wwara w r a (h) ftelnolort (m) a s alt ted, 3„ : f the d ti �°s' >1F t a.. .. �� G.. :'..�'1� t; the "'Nelsons I Y i! �..y-. F � x'��CiGi`tY�.6 P? +9fS�e �, i it'�rt' ��c*"!'�t�.tui '..�x,'^?tt.?>�i� �Q f 3 1A!i its ed,3 I2j1►It8{; hol4 , the ,'3 ene,� 4 the .-scl veep �e�" dX X" -``e �170ti tx �y �yP��..g. 3. t�`,_.Y'l9: Ige l�� fCiGw' pooh �Vili�b'?7 �:�,' f'1l'y� ± `i„F rr t �' `20 `T'h inetz 'aoce does t 7;;.'ly to t �€::'+r or 1! jq�*''j (a) griciag aft of the, , a. .rohip, saes nten, !c , or use . or1 i• a1 thereto, of "may portst r bites �,�. ►;h;es ..r 531'1 c:s�. the �J�'l1;~exi ?�`'�t�.rstr�i t-.1,.1.i:h trade, profession or busing:4ov is klaadt.>lcted or` ai 1 rt sect or held for (Continued on page ) u, ND. C-10747A 2-65 PRINTED IN U.5.A, This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE EXCLUSION (Fairs) It is agreed that the insurance applies with respect to the operation of any fair out of doors subject to the following additional exclusions: The insurance does not apply 1. to bodily injury or property damage arising out of (a) mechanically operated amusement devices owned or operated by the named insured, (b) automobile or motorcycle racing or stunting, (c) rodeos, or 2. to bodily injury to any person while practicing for or participating in any contest or exhibition of an athletic or sports nature sponsored by the named insured. THE CHARTER OAK FIRE INSURANCE COMPANY THE TRAVELERS INDEMNITY COMPANY Secretary Secretary G309 C-11288 7-66 PRINTED IN U.S.A. N.S. This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE EXCLUSION (Malpractice and Professional Services) (Form A) It is agreed that with respect to any operation described below or designated in the policy as subject to this endorsement, the insurance does not apply to bodily injury or property damage due to 1. the rendering of or failure to render (a) medical, surgical, dental, x-ray or nursing service or treatment, or the furnishing of food or beverages in connection therewith;• (b) any service or treatment conducive to health or of a professional nature; or (c) any cosmetic or tonsorial service or treatment; 2. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; or 3. the handling of or performing of autopsies on dead bodies. Description of Operations: Amending Policy No. _ THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY --� - �� Secretary Secretary C-11293 7-66 PRINTED IN O.S.A. N.S. G314 This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following: COMPREHENSIVE GENERAL LIABILITY INSURANCE MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE PRODUCTS HAZARD EXCEPTIONS It is agreed that the products hazard does not include bodily injury or property damage arising out of the named in.sured's products manufactured, sold, handled or distributed in connection with(1) the use of any premises described in this endorse- ment, owned by or rented to the named insured or (2) any operation, described in this endorsement, conducted by or on behalf of the named insured. Description of Premises and Operations: Amending Policy No. THE TRAVELERS INDEMNITY COMPANY THE CHARTER OAK FIRE INSURANCE COMPANY `i�Sec Secretary C-11333 7-66 PRINTED IN U.S.A. N.S. G61O Effective from_ at the time of day the policy becomes effective. Amending Policy No. NSL 2373678 1 8 Issued to Date of Issue: 2/17/695M OFFICE PROD. PROD. FOR 6 CODE CODE 00. qL USE MODE OF LOC.OF USE ADJUST. RISK (The information provided for above,except the policy number,is required to be stated only when this endorsement is issued for attachment to the policy subsequent to its effective date.) It is agreed that as of the effective date hereof the policy is amended in the following particulars: THE FOLLOWING COUNTY COMMISSIONERS ARE ADDITIONAL INSUREDS, BUT ONLY WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES AS SUCH: GLENN K BILLINGS MARSHALL H ANDERSON HAROLD W ANDERSON 8000(A) This endorsement is executed on the reverse side hereof. SYMBOL No. DECLARATIONS SCHEDULE--Genera]Liability Hazards No.___1_____ Policy No. N9;1. 2373678 The letters "MP" wherever used in this schedule shall mean "Premium for Premises Medical Coverage". Inclusion of a premium for Premises Medical Payments Coverage immediately below the Bodily Injury Liability premium for any elevator shall mean that Premises Medical Payments Coverage is afforded with respect to such elevator. In the Rates and Advance Premium columns"BI" means "Bodily Injury Liability"and "PD" means "Property Damage Liability". Location of all premises owned by, rented to or controlled by the named insured (Enter "same" if same location as address shown in Item 1. of declarations): SEE BELOW Interest of named insured in such premises(Describe interest, such as"owner", "general lessee" or"tenant"): UNKNOWN Part occupied by named insured: UNKNOWN Comprehensive General Liability Insurance. The following discloses all hazards insured hereunder known to exist at the effective date of this policy, unless otherwise stated herein: Description of Hazards Code No. Premium Bases" Rates Advance Premium BI I PD BI I PD A—Premises—Operations I A—Area(Sq.Ft.) A—Per 100 Sq.Ft.of Area B—Elevators B—Frontage B—Per Linear Foot C—Independent Contractors C—Remuneration D—Completed Operations D—No. Insured C—Per $100 of ation E—Products E—Cost D—Per er Elevator FF—Receipts —Per$100 of Cost C 11—Sales F F—Per$1000 of Receipts H—Admissions H—Per$1000 of Sales H—Per 100 Admissions AS PER SCHEDULE 8810 3112 2770 Minimum Premiums Premises—Operations Independent Contractors Products BI PD BI PD BI PD C-11 log7-66 P5'NitU IN us.A. (Use with Coy.Parts Ll,9,10, 11,13,14,25) 467 "See over for Description of Premium Bases 8800 DECLARATIONS SCHEDULE—General Liability Hazards No. 2 Policy No. NSL 2373678 Description of Hazards Code No. Premium Bases Rates Advance Premium BI PD BI PD A. BUILDINGS OR PREMISES 01.22 HOMES FOR THE AGED (SUBJ TO END. 0314 & G610) 01475 FAIR GROUNDS - NON-OPERATIONS SEASON (SUBJ TO END. 6309) 03018 EXHIBITION BUILDINGS 01918* -13,500 .296 .0049 1}0 1 PRIVATE RESIDENCES - N.O.C. INITIAL RESIDENCE 0338* ACH-1 .42 1.154 3 1 (SUBJ TO END. G210A) ADDITIONAL RESIDENCE 0770* ACH-3 .05 .304 6 1 (SUBJ TO END. G210A) LIBRARIES OR MUSEUMS 0132* ,600 .150 .0036 14 1 STREETS, ROADS OR HIGHWAYS - WITH OR WITHOUT SIDEWALKS - INCLUDING BRIDGES AND CULVETS BUT EXCLUDING TOLL ROADS, TOLL BRIDGES, AND DRAWBRIDGES, EXISTENCE MILES ONLY 0376* 5010 .111 .047 556 235 9TH AVE & STREET - GREELEY, COLORADO 0122* A-108,932.383 .0185 417 20 1027-10TH STREET - GREELEY, COLORADO 0122* A-8,800 383 .0185 34 2 0147* A-12,160 189 .0085 23 1 ISLAND GROVE PARK - GREELEY. COLORADO 0122* A-12,158 383 .0185 47 2 01918* A-13,500 296 .0049 40 1 FL T C ARGE 03018* B-100 FOR MINIMUM 5 11 C-11167 7-66 PRINTED is U.S.A. KDS,KHPS,KSLG,NSL,BL 8810 ODS,OHPS,OSLG,ONSL,OBL DECLARATIONS SCHEDULE—General Liability Hazards No. 3 Policy No. NSL 2373678 Description of Hazards Code No. Premium Bases Rates Advance Premium BI PD BI PD A. MUNICIPAL, TOWNSHIP, COUNTY OR STATE EMPLOYEES - N.O.C. 2457 C-607,50 .014 .140 91 85 A. POLICEMEN 3762 C-140,00 .102 .197 143 276 A. AUTOMOBILE GARAGES, REPAIR SHOPS, SALES AGENCIES OR STORAGE GARAGES, ALL EMPLOYEES OTHER THAN AUTOMOBILE SALESMEN, INCLUDING PARTS DEPARTMENT EMPLOYEES 3437 C-52,300 .139 .076 73 40 A. STREET OR ROAD PAVING OR REPAVING, SURFACING OR RESURFACING OR SCRAPING 5506 XCU C-530,00 .297 .388 1574 2056 ( I-.318-11-.11+1) EXCESS LIMITS CHARGE 9890 10 , 5 , B. MUNICIPAL, STATE OR FEDERAL ICE BUILDING ELEVATORS NOT ONE STORY 015* EACH-I4. 61.6 2.12 247 9 HOSPITAL ELEVATORS - NOT PUSH BUTTON CONTROLLED OR ONE- STORY 057* EACH-1 1+7.2 2.12 47 2 C. CONSTRUCTION OPERATIONS - OWNER N.O.C. (NOT RAILROADS)-EXCLUDING MINIMUM OPERATIONS ON BOARD SHIPS 0512 E-IF ANY .013 .007 16 11 D. STORES - REFRESHMENT STANDS MINIMUM (SUBJ TO END. G611 ) 1172 G-2,500 .059 .005 25 9 C-11167 7-66 PRINTED IN U.S A. KDS,KIPS,KSLG,NSL,BL 8810 ODS,OHPS,OSLG,ONSL,OBL DECLARATIONS SCHEDULE—Automobile Liability Hazards No.--_4-- Policy No. NM— 2373678 Owned Automobiles The purposes of use of the automobile are "Pleasure and Business" unless otherwise stated. The abbreviation "C" in the "Purposes of Use" column shall mean "Commercial", the abbreviation "C—LT" shall mean "Commercial—(Local Truckman)" and the abbreviation "C—LHT" shall mean "Commercial—(Long Haul Truckman)". The abbreviation "UM"preceding a premium in the Bodily Injury Liability premium column shall mean "Premium for Uninsured Motorists Coverage". Number of Licensed Owned Automobiles, Exclusive of Trailers Average Graded Advance Premium Reduction 18.8 % Town and State Number and Purposes Rates Advance Premiums in which the automobiles Class of of Bodily Property Division 1 Bodily Property Division I will be principally garaged Automobiles Use Injury Damage Medical Injury Damage Medical Liability Liability Payments Liability Liability Payments ROAD DISTRICT NO. 1371. 374 54-logo c 11 2 11 2 1 5 0 25 1-b1-6 P&B 26 17 26 17 3 BUSSE 22 10 66 30 (0-30 PASS) ROAD DISTRICT NO. 2 34..8CA C 11 11 374 374 5-508c P617 26 17 -61-B &B 26 ROAD DISTRICT NO. 3 31-8CA AC 116 11 5 3+1 380 96 1--iO%8C C 2 1 2 1 CUSTODIAN 1-8CA C 11 11 11 11 CIVIL DEFENSE 1-8CA C 11 11 11 11 COUNTY CLERK 1-61-B P&B 26 17 26 17 PLANNING COMMISSION 1-61-B P&B 26 17 26 17 a LIBRARY 2-8CA C 11 11 22 22 1-61-B P&B 26 17 26 17 COUNTY AGENT 7-8CA C 11 11 77 77 GENERAL HOSPITAL 2-8CA C 11 11' 22 22 2-fit-B P&B 26 17 52 34 s M E 1-50%8C C 6 5 6 5 UNLICENSED 2-8CA C 11 11 22 22 WELFARE 1-8CA C 11 11 11 11 COUNTY SHOP 6-8CA C 11 11 66 66 2-50%8C P&B 26 17 52 10 C-11179 7-66 PAINTED IN U s.A. NSL, SLA, MV, BL 8890 ONSL,OSLA,OOMV,OBL DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 5 Policy No. NSL 2373678 {8 Owned Automobiles The purposes of use of the automobile are "Pleasure and Business" unless otherwise stated. The abbreviation "C" in the "Purposes of Use" column shall mean "Commercial", the abbreviation "C—LT" shall mean "Commercial—(Local Truckman)" and the abbreviation "C—LHT" shall mean"Commercial—(Long Haul Truckman)". The abbreviation"UM"preceding a premium in the Bodily Injury Liability premium column shall mean "Premium for Uninsured Motorists Coverage". Number of Licensed Owned Automobiles, Exclusive of Trailers Average Graded Advance Premium Reduction Town and State Number and Purposes Rates Advance Premiums _ in which the automobiles Class of of Bodily Property Division 1 Bodily Property Division I will be principally garaged Automobiles Use Injury Damage Medical Injury Damage Medical Liability Liability Payments Liability Liability Payments SHERIFF 9-61-B PCB 26 17 234 153 NURSING HOME 1-8CA C 11 11 11 11 • • C-11179 7-66 PRINTED IN N.S.A. NSL SI.A, MV BL 8890 ONSL,OSLA,OO1dV,OBL DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 6 Policy No. NSL 2373678 In the Rates and Advance Premium columns"BI"means"Bodily Injury Liability","PD"means"Property Damage Liability"and"Med.Pays." means "Division 1. Medical Payments". Advance Premium Description of Hazards HI PD Med.Pays_ 1. Owned Automobiles Premium Basis—Per Automobile See other Declarations Schedule(s)—Automobile Liability Hazards 205(} 1825 2. Hired Automobiles Premium Basis—Cost of Hiref Purposes Estimated Rates per$100 Cost of Hire Locations Where Automobiles of Types Hired Will Be Principally Used Use* Hire Hir of re BI PD COMM'L GREELEY, COLORADO CL8 IF ANY .378 .325 INCL DED P P GREELEY, COLORADO P&8 IF ANY .831 .472 3. Non-Owned Automobiles Premium Basis—Class 1 Persons and Class 2 Employeesf Rates per Person Class 1 Persons— Location of Headquarters Name of Each of Persona Named Herein BI PD 38 GREELEY, COLORADO 3.02 1 .77 115 67 Rates per Employee Class 2 Employees— Location of Headquarters Estimated Average Number of Class 2 Employees BI PD 1}00 GREELEY, COLORADO .258 .118 103 47 *The purposes of use of the automobile are"Pleasure and Business"unless otherwise stated. The abbreviation"C"in the"Purposes of Use"column shall mean "Commercial," the abbreviation "C-LT" shall mean "Commercial-(Local Truckman)" and the abbreviation "C-LHT" shall mean "Commercial-(Long Haul Truckman)." C-11177 7-66 PR'NIED IN U.S.A. NSL,BLA,BL OSL,OSLA,OBL,MV 467 t tlon of Premium Bases 8840 See over for Description DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 7 Policy No,NSL 2373678 (See reverse side for explanation of certain entries or the absence thereof,) COVERAGES + PREMIUMS PREMIUMS For Company Use Only No. The automobile will be principally garaged at BODILY INJURY — aJRmt MUE LIABILITY MA CLASS TEAR, LTS. COY. I Cq1, SYM.AGE AR FR 1 GREELEY, COLORADO PROPERTY DAM- — ---I AGE LIABILITY Description of automobile* MEDICPAE s 1967 CHEV DUMP TRUCK COMPREHENSIVE Y ./� �t �^ R ST. CLASS USE LpV. SYN. AGE Sli. Ag EXP. Tp JM717!0102 508 COLLISION 195 U TER.TER. LT. LT, Cos Mrs Date Purchased New or Used IT List Price(L)or Actual Cost(A) Rate*" FIRE 27 FOR H,O, CN:15,500 THEFT INCL USE Purposes of Use Limitof Liability" Collision-Ain't Deductible*"" I ACV ( 500. No. The automobile will be principally garaged at(Same as above,unless otherwise slated) BODILY INJURY suAcwmeE MA CLASS TEAR, LTS, COY. COLL. SYM-AGE LIABILITYI M FA 2 PROPERTY DAM- —— AGE LIABILITY Description of automobile" MEDICAL PAYMENTS 1967 INTERNATIONAL 3T TANDEM TRUCK COMPREHENSIVE — COI pa 2119226238952 COLLISION 135 C A53 VSE V TER.TER. LT. LT. co COY, SYM. AGE S0., as s EXP. Date Purchased New or Used List Price(L)or Actual Cost(A) Rate" FIRE 27 FOR CN:17,000 THEFT INCL USE _ Purposes of Use Limit of Liability" Collision-Ain't Deductible*** ACV 500. No. The automobile will be principally garaged at(Same as above,unless otherwise stated) BODILY INJURY suAcxARGE LIABILITY MA CLASS TERA. LTS. CDV. COLL. SYM.AGE AR FR 3 PROPERTY DAM- AGE LIABILITY Description of automobile* MEDICAL PAYMENTS 1966 FORD COMPREHENSIVE Al. ` # T85KU78299 ST, CLASS USE f pun. TA. P.O. COY. Ces SYM. AGE SPL. CMa EXP. COLLISION 135 rQ TER. TEA, LT. LT, Date Purchased I New or Used List Price(L)or Actual Cost (A) Rate"* FIRE _ •�9 FOR CN:16,600 THEF INCL U E Purposes of Use Limit of Liability" Collision-Ain't Deductible""* ACV 500. - No. The automobile will be principally garaged at(same or above,unless otherwise slated) BODILY INJURY LIABILITY MA CLASS TEAR. LTS. COY. COLL, SYM,AGE amCIFR __ AR Ffl — .--4— PROPERTY DAM- AGE LIABILITY Description of automobile* MEDICAL PAYMENTS _ 1962 TRUCK TRACTOR COMPREHENSIVE — f GUR. Tfl. a.l. P.D. AI A0. ST. CLASS USE COV, Lvv. SYM. AGE SR. C EXP. 8# 625 611 COLLISION 6 w TER,TER. LT. LT. Date Purchased New or Used List Price(L)or Actual Cost(A) Rate** FIRE 2a FOR 1 H,O. ttq� THEFT INCL USE Purposes of Use 6Yimito lal�iBCy Collision-Am't Deductible""" ACV I 500. No. Name and Address of Mortgagee(The number opposite each entry indicates the automobile Number of Licensed ,c to Owned Automobiles, n .--L EL- Manual or EX- to which the entry applies, such automobile being identified by the same number above.) Exclusive of Trailers 3 perience Rate Advance Premium a'c ,*v Number of e U p Licensed Automobile OI'D. 3 C y p=M w M ,C S Average Graded Advance 3 n r'n Premium °a Ia- Premium Reduction 0 r ea,.c Reduction_% o % .c_C r r Advance Premium Complete on last schedule only e C-11178 7-66 PRINTED IN U.S.A. MV, MA,NSL,SLA,BI,GG,OOMV,OMA, OSL, OSLA,OBL, OGG 167 8870 DECLARATIONS SCHEDULE—Automobile Liability Hazards No. 8 Policy No. NSL 2373678 (See reverse side for explanation of certain entries or the absence thereof.) COVERAGES + PREMIUMS PREMIUMS For Company Use Only -— No. The automobile will be principally garaged at BODILY INJURY asACHARBE LIABILITY MA CLASS TERR. LTS, COY, COLL, SYM. AGE AR I PR 5 GREELEY, COLORADO PROPERTY DAM- - AGE LIABILITY Description of automobile" MEDICAL PAYMENTS 1966 CHEV TANDEM DUMP TRUCK COMPREHENSIVE BUR. TR. 8.1. P.D. CD AN ST, CLASS USE fO TER. TER. LT. LT. COY. CUY. SYM. AGE SPL.C EXP. M8536-P105612 COLLISION Jle21j. ate Purcl d Now or UMd List Price(L)or Actual Cost(A) Rate" FI15IRE — ♦ FOR 4� H.O. CN: l000 THEFT INCL USE Purposes of Use Limit of ❑ity" Collision-Ain't Deductible""" / ACV 500. No. The automobile will be principally garaged at(Same as above,antes otherwise staled) BODILY INJURY LIABILITY Mil (L SuRCNARBE ASS TERN, LTS. COV, COLL, SYM.AGE M FR 6 PROPERTY DAM - — --- I AGE LIABILITY Description of automobile MEDICAL PAYMENTS 1965 DD0GE TRUCK W/GALLON DUMP COMPREHENSIVE f( G- IT p ST. CLASS USE $ COY. St:: SYM. AGE SPL. Cbn EXP, Q 8 1 ?43 5881'-52 -h8 COLLISION 135 TER.TER. LT. LT. to Pu h ew or U List (L)or A 1 Cwt(A) Rate"-+ ` 5 FOR FIRE 19 CN"17,00© THEFT IN USE — cL USE Purposes of Use Limit of Liability" Collision-Am't Deductible""" IACV I 500. - • No. The automobile will be principally garaged at(Same as above,unless otherwise staled) BODILY INJURY sURCHARBE LIABILITY Mil CLASS TERN. LTS. COV. COLL. SYM. AGE MI FR 7 PROPERTY DAM- - AGE LIABILITY Description of automobile MEDICAL PAYMENTS 1966 FORD TRUCK DUMP BODY COMPREHENSIVE - ST. CU55 USE BUR. TR, RI. P.D, Wr: SYM, AGE SPL. tat EXP. 485L08y.97 COLLISION 195 8 IS TER. TER. LT. LT. COY. Date Purchased New wilted List Price(L)or Actual Cost (A) Rate" ICN:15,500THEFT FIRE 19 FOR THE - INCL H.D. USE Purposes of Use Limit of Liability" Collision-Am's Deductiblee" IACV 500. ) No. The automobile will be principally garaged at(Same as above,unless otherwise slated) BODILY INJURY MSRCHAfloE LIABILITY MA CLASS TERN. LTS. CDV, COLL. SYM,AGE AR FR 8 PROPERTY DAM- AGE LIABILITY — — - Description of automobile" MEDICAL M PAYMENTS _ 1957 GC COMPREHENSIVE — ST, CLASS USE >F BUR, TR, al, P.O. COY. CUB. SYM, AGE SPL, A R' EXP. �11yy ��.s �t�(��r��g�[ COLLISION u TER,TER. LT. LT. CUY. CIe51 its aMIaiB"F IRAQ23€1IL(L)or Actual Cost(A) Rate"" — FIRE 49 FOR CA:17,900 THEFT — INN. USE } Purposes of Use Limit of Liability" Collision-Ain't Deductible"' IACV 500. — No. Name and Address of Mortgagee(The number opposite each entry indicates the automobile Number of Licensed g ;tp Owned Automobiles- R a Total Manual or Ex- to which the entry applies,such automobile being identified by the same number above.) Exclusive of Trailers n ^ _ perience Rate Advance Premium or v Number of Y oozy Licensed Automobile• t�'a ;W .-..if Oo_ 0, ==a Average Graded Advance 3 y r n Premium ap n Premium Reduction a r' g Reduction % e, 9 P O 0 f _g ' Advance Premium Complete on last schedule only C-11178 7.66 PRINTED IN U.S.A. MV, MA,NSL,SLA,BL, GG,OOMV,OMA, OSL,OSLA, OBL, OGG 167 8870 DECLARATIONS SCHEDULE—Automobile Liability Hazards No. _ Policy No. NSL 2373678 (See reverse side for explanation of certain entries or the absence thereof.) COVERAGES + PREMIUMS PREMIUMS For Company Use Only - - No. The automobile will be principally garaged at BoonLY INJURY — RC SUHARGE LIABILITY M/L CLASS TERR. LTS. WV. COLL. SYM. AGE AR q GREELEY, COLORADO PROPERTY DAM- - -- I FR AGE LIABILITY Description of automobile* MEDICAL HC PAYMENTS 1968 I COMPREHENSIVE N # 757921 6310626 COLLISION 146 ST. CLASS USE E TER. TR. B.I. P.O, pV. 21 SYM. AGE SR. EL y TER.TER. LT. LT. Date Purchased I New or Used List Price(L)or Actual Coat(A) Rate** FIRE 22 FOR CN.18,000 THEFTNCI USE Purposes of Use Limit of Liability*" Collision-Am't Deductible*** ' ACV I 500. No. The automobile will be principally garaged at(Same as above,unless otherwise stated) BODILY INJURY LIABILITY M/L I CLASS I TERR. LTS. WV. COLL. SYM.ABE Ta°C p PROPERTY DAM- — AGE LIABILITY Description of automobile* MEDICAL - - PAYMENTS — COMPREHENSIVE Y — ST. CLASS USE t BUR. TB. B.I. P.D. COV. COY. SYM. AGE SPI. EXP. V TER.TER. LT. LT. COLLISION Date Purchased I New or Used List Price(L)or Actual Cost(A) Rate" FIRE _ FOR THEFT >H.O. USE — Purposes of Use Limit of Liability** Collision-Am't Deductible*** — No. The automobile will be principally garaged at(Some os above.unless otherwise stated) BODILY IwURr SURCHARGE LIABILITY M/L CLASS TERR.LTS.WV.COLL.SYM.AGE AR I Fe. PROPERTY DAM- LIABILITY Description of automobile* MEDICAL PAYMENTS _ COMPREHENSIVE ST. CLASS USE f BUR. TR. B.I. P.O. OV. :Y SYM. AGE SPL. Al EXP. COLLISION g TER. TER. LT. LT. Date Purchased I New or Used List Price(L)or Actual Cost (A) Rate*" FIRE FOR H.O. THEFT USE Purposes of Use Limit of Liability** (Collision-Am't Deductible'"+ — j No. The automobile will be principally garaged at(Same as above,unless otherwise slated) BODILY INJURY sURGNRGE M/L CLASS TERR. LTS. WV. ROLL. SYM.AGE LIABILITY AR FR PROPERTY DAM- — AGE LIABILITY Description of automobile MEDICAL PAYMENTS — COMPREHENSIVEii:— ST. CLASS um p BUR. TR. B.I. P.D. WV. P'*II' SYM. AGE SPL. A'R' EXP. COLLISION ° TER.TER. LT. LT. COY. as Date Purchased New or Used List Price(L)or Actual Cost(A) Rate* FIRE FOR ) r H.O. ' THEFT USE — Purposes of Use Limit of Liability** Collision-Am't Deductible*** No. Name and Address of Mortgagee(The number opposite each entry indicates the automobile Number of I.icensed MD '°m Owned Automobiles. °'° oa Total Manual or Er- 1 237 to which the entry applies, such automobile being identified by the same number above.) Exclusive of Trailers 3 perience Rate Advance Premium ii -v Number of ei t7 2,11 Licensed Automobile' 9 o e v 3 + n Ds n `e c Average Graded Advance 3 t'n Premium 4. B r Premium Reduction 1 r d c Reduction—1k o .. -M o $ 1183 .� Advance Premium Complete on last schedule only C-11178 7.66 PRINTED IN U.S.A. MV, MA,NSL,SLA,BL,GG,OOMV,OMA, OSL, OSLA,OBL,OGG 167 8870 COMPREHENSIVE GENERAL LIABILITY INSURANCE COVERAGE PART I. Coverage A—Bodily Injury Liability ♦ tributing, selling or serving alcoholic beverages or as an owner or lessor of premises used for such purposes, by Coverage B—Property Damage Liability reason of the selling, serving or giving of any alcoholic The company will pay on behalf of the insured all sums which the beverage insured shall become legally obligated to pay as damages because 1 in violation of of ( ) any statute, ordinance or regulation, Coverage A. bodily injury or (2) to a minor, Coverage B. property damage (3) to a person under the influence of alcohol, or to which this insurance applies, caused by an occurrence, and the (4) which causes or contributes to the intoxication of any company shall have the right and duty to defend any suit person; against the insured seeking damages on account of such bodily injury or property damage, even if any of the allegations of the (g) to any obligation for which the insured or any carrier as his suit are groundless, false or fraudulent, and may make such insurer may be held liable under any workmen's compen- investigation and settlement of any claim or suit as it deems lotion, unemployment compensation or disability benefits expedient, but the company shall not be obligated to pay any law, or under any similar law; claim or judgment or to defend any suit after the applicable limit (h) to bodily injury to any employee of the insured arising out of the company's liability has been exhausted by payment of of and in the course of his employment by the insured;but judgments or settlements. this exclusion does not apply to liability assumed by the insured under an incidental contract; Exclusions (i) to property damage to (1) property owned or occupied by or rented to the insured, This insurance does not apply: (2) property used by the insured, or (a) to liability assumed by the insured under any contract or agreement except an incidental contract;but this exclusion (3) property in the care, custody or control of the insured does not apply to a warranty of fitness or quality of the or as to which the insured is for any purpose exercising named insured's products or a warranty that work per- physical control; formed by or on behalf of the named insured will he done in but parts (2) and (3) of this exclusion do not apply with a workmanlike manner; respect to liability under a written sidetrack agreement and part (3) of this exclusion does not apply with respect to (b) to bow injury or property damage arising out of the owner- property damage (other than to elevators)arising out of the ship, maintenance, operation, use, loading or unloading of use of an elevator at premises owned by, rented to or con- (1) any automobile or aircraft owned or operated by or trolled by the named insured; rented or loaned to the named insured, or (j) to property damage p y g to premises alienated by the named (2) ally other automobile or aircraft operated by any person insured arising out of such premises or any part thereof; in the course of his employment by the named insured; (k) to bodily injury or property damage resulting from the failure but this exclusion does not apply to the parking of an of the named insured's products or work completed by or for automobile on premises owned by,rented to or controlled by the named insured to perform the function or serve the the named insured or the ways immediately adjoining, if purpose intended by the named insured, if such failure is such automobile is not owned by or rented or loaned to the due to a mistake or deficiency in any design,formula,plan, named insured; specifications, advertising material or printed instructions (c) to bodily injury or property damage arising out of and in the prepared or developed by any insured; but this exclusion course of the transportation of mobile equipment by an does not apply to bodily injury or property damage resulting automobile owned or operated by or rented or loaned to the from the active malfunctioning of such products or work; named insured; (I) to property damage to the named insured's products arising (d) to bodily injury or property damage arising out of the owner- out of such products or any part of such products; ship, maintenance, operation, use, loading or unloading of (m)to property damage to work performed by or on behalf of the any watercraft, if the bodily injury or property damage named insured arisin out of the work or an occurs away from premises owned by, rented to or con- g n portion there- trolled by the named insured; but this exclusion does not co, nr tiot t materials, parts or equipment furnished in apply to bodily injury or property damage included within connection therewith; the products hazard or the completed operations hazard or (n) to damages claimed for the withdrawal, inspection, repair, resulting from operations performed for the named insured replacement, or loss of use of the named insured's products by independent contractors or to liability assumed by the or work completed by or for the named insured or of any insured under an incidental contract; property of which such products or work form a part, if e to bodily injury or property damage due to.war, whether or such products, work or property are withdrawn from the ( ) y p p y g' market or from use because of any known or suspected not declared,civil war,insurrection,rebellion or revolution defect or deficiency therein. or to any act or condition incident to any of the foregoing, with respect to (1) liability assumed by the insured under an incidental II. Persons Insured contract, or Each of the following is an insured under this insurance to the (2) expenses for first aid under the Supplementary Pay- extent set forth below: ments provision; (a) if the named insured is designated in the declarations as an (f) to bodily injury or property damage for which the insured or individual, the person so designated but only with respect his indemnitee may be held liable, as a person or organi- to the conduct of a business of which he is the sole pro- zation engaged in the business of manufacturing, din- prietor; (Continued on page 2) L I Page 2 (b) if the named insured is designated in the declarations as a Subject to the above provisions respecting "each person" and partnership or joint venture, the partnership or joint "each occurrence", the total liability of the company for all venture so designated and any partner or member thereof damages bleted ecause (1)s all bodiand ly(2)injury included injury within i the but only with respect to his liability as such; cwithin the products hazard shall not exceed the limit of bodily (c) if the named insured is designated in the declarations as injury liability stated in the declarations as "aggregate". other than an individual, partnership or joint venture, the organization so designated and any executive officer, Coverage B—The total liability of the company for all damages director ope ofhis duties as such;thereof while acting within the because of all property damage sustained by one or more persons or scope duties as organizations as the result of any one occurrence shall not exceed (d) any person (other than an employee of the named insured) the limit of property damage liability stated in the declarations or organization while acting as real estate manager for the as applicable to "each occurrence". named insured;and Subject to the above provision respecting "each occurrence", the (e) with respect to the operation,for the purpose of locomotion total liability oft the company[hs coverage applies damages because e auseibed all upon a public highway,c of mobile equipment registered under property the numbered subparagraphs below shall not exceed the in any motor vehicle registration law, limit of property damage liability stated in the declarations as (i) an employee of the named insured while operating any "aggregate": such equipment in the course of his employment, and (ii) any other person while operating with the permission (1) all property damage arising out of premises or operations of the named insured any such equipment registered in rated on a remuneration basis or contractor's equipment the name of the named insured and any person or rated on a receipts basis, including property damage for organization legally responsible for such operation,but which liability is assumed under any incidental contract only if there is no other valid and collectible insurance relating to such premises or operations, but excluding available, either on a primary or excess basis, to such property damage included in subparagraph (2) below; person or organization; (2) all property damage arising out of and occurring in the provided that no person or organization shall he an insured independent course o fp contractors performed genera the l supervisionnanamed insured ns the by reof by under this paragraph (e)with respect to: the named insured, including any such property damage for (1) bodily injury to any fellow employee of such person which liability is assumed under any incidental contract injured in the course of his employment, or relating to such operations, but this subparagraph(2)does not include property damage arising out of maintenance or (2) property damage to property owned by, rented to, in repairs at premises owned by or rented to the named charge of or occupied by the named insured or the insured or structural alterations at such premises which do employer of any person described in subparagraph(ii). not involve changing the size of or moving buildings or This insurance t fdoes not apply t f bodily t injury or prop e damage other structures; arising out of the conduct of any partnership or joint venture of (3) all property damage included within the products hazard and which the insured is a partner or member and which is not all property damage included within the completed operations designated in this policy as a named insured. hazard. Such aggregate limit shall apply separately to the property damage described in subparagraphs (1), (2) and (3), above, and III. Limits of Liability under subparagraphs(1)and(2), separately with respect to each Regardless of the number of (1) insureds under this policy, (2) project away from premises owned by or rented to the named persons or organizations who sustain bodily injury or property insured. damage, or(3)claims made or suits brought on account of bodily injury or property damage, the company s liability is limited as Coverages A and B—For the purpose of determining the limit of follows: the company's liability, all bodily injury and property damage Coverage A—The limit of bodily injury liability stated in the arising out of continuous or repeated exposure to substantially declarations as applicable to "each person" is the limit of the the same general conditions shall be considered as arising out of company's liability for all damages because of bodily injury one occurrence. sustained by one person as the result of any one occurrence; but subject to the above provision respecting"each person",the tot al liability of the company for all damages because of bodily injuryIV. Policy Period;Territory sustained by two or more persons as the result of any one occur- PP only bodily injury property damage rence shall not exceed the limit of bodily injury liability stated in This his insurance occurs a appl the tpolico boi within oho pokey tey. the declarations as applicable to"each occurrence". C-11139 Edition July 1,1966 PRINTED IN U.S.A. N.S.(CGL) COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE COVERAGE PART I. Coverage C—Bodily Injury Liability s (1) a lessee or borrower of the automobile, or Coverage D—Property Damage Liability (2) an employee of the named insured or of such lessee or The company will pay on behalf of the insured all sums which the borrower; insured shall become legally obligated to pay as damages because (d) any other person or organization but only with respect to of his or its liability because of acts or omissions of an insured Coverage C. bodily injury or under (a), (b)or(c)above. Coverage D. property damage to which this insurance applies, caused by an occurrence and None of the following is an insured: arising out of the ownership, maintenance or use, including loading and unloading, of any automobile, and the company shall (') any person while engaged in the business of his employer have the right and duty to defend any suit against the insured with respect to bodily injury to any fellow employee of seeking damages on account of such bodily injury or property such person injured in the course of his employment; damage, even if any of the allegations of the suit are groundless, (ii) the owner or lessee (of whom the named insured is a sub- false or fraudulent, and may make such investigation and settle- ment of any claim or suit as it deems expedient,but the company lessee) of a hired a gentoor a or the owner of anon-owned shall not be obligated to pay any claim or judgment or to defend automobile,or any agent or mplovce of any such owner or any suit after the applicable limit of the company's liability has lessee; been exhausted by payment of judgments or settlements. (iii) an executive officer with respect to an automobile owned by him or by a member of his household; Exclusions (iv) any person or organization, other than the named insured, This insurance does not apply:I with respect to: (a) to liability assumed by the insured under any contract or (1) a motor vehicle while used with any trailer owned or agreement; hired by such person or organization and not covered by like insurance in the company (except a trailer (b) to any obligation for which the insured or any carrier as his designed for use with a private passenger automobile insurer may he held liable under any workmen's cornpen- and not being used for business purposes with another sation, unemployment compensation or disability benefits type motor vehicle), or law, or under any similar law; (2) a trailer while used with any motor vehicle owned or (c) to bodily injury to any employee of the insured arising out hired by such person or organization and not covered of and in the course of his employment by the insured, but by like insurance in the company: this exclusion does not apply to any such injury arising out of and in the course of domestic employment by the insured (v) any person while employed ill or otherwise engaged in unless benefits therefor are in whole or in part either pay- duties in connection with an automobile business, other able or required to be provided under any workmen's than an automobile business operated by the named insured. compensation law; This insurance does not apply to bodily injury or property damage (d) to property damage to arising out of (1) a non-owned automobile used in the conduct of (1) property owned or being transported by the insured,or any partnership or joint venture of which the insured is a partner (2) property rented to or in the care,custody or control of or member and which is not designated in this policy as a named the insured,or as to which the insured is for any purpose insured,or(2)if the named insured is a partnership,an automobile exercising physical control, other than property damage owned by or registered in the name of a partner thereof. to a residence or private garage by a private passenger automobile covered by this insurance; (e) to bodily injury due to war, whether or not declared, civil III. Limits of Liability war, insurrection, rebellion or revolution or to any act or Regardless of the number of (1) insureds under this policy, (2) condition incident to any of the foregoing, with respect to persons or organizations who sustain bodily injury or property expenses for first aid under the Supplementary Payments damage, (3) claims made or suits brought on account of bodily provision. injury or property damage or (4)automobiles to which this policy applies, the company's liability is limited as follows: II. Persons Insured Each of the following is an insured under this insurance to the Coverage C—The limit of bodily injury liability stated in the extent set forth below: declarations as applicable to "each person" is the limit of the company's liability for all damages because of bodily injury (a) the named insured; sustained by one person as the result of ally one occurrence; but subject to the above provision respecting"each person", the total (b) any partner or executive officer thereof, but with respect to liability of the company for all damages because of bodily injury a non-owned automobile only while such automobile is being sustained by two or more persons as the result of any one occur- used in the business of the named insured; rence shall not exceed the limit of bodily injury liability stated in the declarations as applicable to "each occurrence". (c) any other person while using an owned automobile or a hired automobile with the permission of the named insured, provided his actual operation or(if he is not operating)his Coverage D—The total liability of the company for all damages other actual use thereof is within the scope of such per- because of all property damage sustained by one or more persons or mission, but with respect to bodily injury or property organizations as the result of any one occurrence shall not exceed damage arising out of the loading or unloading thereof,such the limit of property damage liability stated in the declarations as other person shall be an insured only if he is: applicable to "each occurrence". (Continued on page 2) L 2A Page 2 Coverages C and D—For the purpose of determining the limit of loaned to, the named insured, provided such automobile is not the company's liability, all bodily injury and property damage owned by or registered in the name of(a)a partner or executive arising out of continuous or repeated exposure to substantially officer of the named insured or(b)an employee or agent of the the same general conditions shall be considered as arising out of named insured who is granted an operating allowance of any one occurrence. sort for the use of such automobile; "non-owned automobile"means an automobile which is neither an owned automobile nor a hired automobile; IV. Policy Period;Territory "owned automobile" means an automobile owned by the named This insurance applies only to bodily injury or property damage insured; which occurs during the policy period within the territory described in paragraph (1) or (2) of the definition of policy "private passenger automobile" means a four wheel private territory. passenger or station wagon type automobile; "trailer" includes semi-trailer but does not include mobile V. Additional Definitions equipment. When used in reference to this insurance(including endorsements forming a part of the policy): VI. Additional Condition "automobile business" means the business or occupation of Excess Insurance—Hired and Non-Owned Automobiles selling, repairing, servicing, storing or parking automobiles; With respect to a hired automobile or a non-owned automobile, this "hired automobile" means an automobile not owned by the insurance shall be excess insurance over any other valid and named insured which is used under contract in behalf of, or collectible insurance available to the insured. C-11952 Edition October 1,1966 P RI NT ED IN V.S.A. H.S. (CAL) L 2A AUTOMOBILE PHYSICAL DAMAGE INSURANCE COVERAGE PART Page 1 SCHEDULE — Automobile Physical Damage Insurance Forming part of Policy No. NSL 2373678 PHD Item 1. The insurance afforded is only with respect to such of the following Coverages as are indicated in the declarations by specific premium charge or charges, and under each such Coverage, applies only to such covered automobiles as are indicated, by entry herein, of one or more of the designating numerals for that purpose appearing in PHD Item 5. The limit of the company's lia- bility against each such Coverage shall be as stated or designated herein and in the declarations, subject to all the terms of this insurance having reference thereto. Covered Limit of Liability — Each covered automobile f PREM, 9 AutomobilesONE YR.q. Coverages 0 0NE NYESE O. Comprehensive 0 P. Collision 5 1183 Q. Fire, Lightning or Transportation 5 ) As separately stated in the declarations p 193 R. Theft 5 q I NCL S. Combined Additional s T. Towing $25 for each disablement Maximum Limit of Liability Records to be submitted: $ Any one covered automobile ❑ monthly quarterly ❑ semi-annually $ All covered automobiles at any one location $ All covered automobiles PHD Item 2. Covered Automobiles as of Effective Date of this Insurance — As separately stated in declarations schedules. PHD Item 3. Except with respect to bailment lease, conditional sale, purchase agreement, mortgage or other encumbrance, the named insured is the sole owner of every covered automobile designated in PHD Item 1 as covered under this insurance, unless, otherwise stated herein: PHD Item 4. Business of the named insured is PHD Item 5. Explanation of entries in PHD Item 1 for designating the covered automobiles to which this insurance applies, under each Coverage afforded: Fleet Automatic When so entered in addition to numerals 1, 2, 3 or 4: 1 = all covered automobiles 6= excluding vehicles leased to the named insured 2-all registered covered automobiles 7=excluding, under Collision Coverage, any vehicle 3=all covered automobiles of the private passenger type 4=all covered automobiles of the commercial type not having an actual cash value of at least $ Non-Fleet 8 5=the covered automobiles described in PHD Item 2 (including newly acquired vehicles, subject to the pro- visions of paragraph (b) of the "covered automobile" definition) Any loss under Coverages other than Towing is payable as interest may appear to the named insured and the Loss Payee named in the declarations as a Mortgagee. • I. Coverage Agreements (a) windstorm, hail, earthquake or explosion, 1. The company will pay for loss to covered automobiles: (b) riot or civil commotion, under Coverage 0. Comprehensive— from any cause except (c) the forced landing or falling of any aircraft or its collision; but, for the purpose of this coverage, hreakage parts or equipment, of glass and loss caused by missiles, falling objects, (dl malicious mischief or vandalism, fire, theft or larceny, windstorm, hail, earthquake, ex- (e) flood or rising waters, or plosion, riot or civil commotion, malicious mischief or (fl external discharge or leakage of water; vandalism, water, flood, or (as to a covered automobile provided that, with respect to each covered automobile, of the private passenger type) colliding with a bird or (i) under the Comprehensive coverage (except as to loss animal, shall not be deemed loss caused by collision; from any of the causes described in the Fire, Light- under Coverage P. Collision—caused by toll is ion; ning or Transportation coverage) and under the Col- under Coverage Q. Fire, Lightning or Transportation—caused lis ion coverage,such payment shall be only for the amount by of each loss in excess of the deductible amount, if (a) fire or lightning, any, stated in the declarations as applicable thereto; (b) smoke or smudge due to a sudden, unusual arid faulty (ii) under the Combined Additional coverage, $25 shall operation of any fixed heating equipment serving he deducted from the amount of each loss caused by the premises in which the covered automobile is malicious mischief or vandalism. located, or 2. The company will pay: (c) the stranding, sinking, burning, collision or derailment . of any conveyance in or upon which the covered auto- under Coverage T. Towing—for towing and labor costs mobile is being transported; necessitated by the disablement of covered automobiles, provided the labor is performed at the place of disable- under Coverage R. Theft— caused by theft or larceny; ment. under Coverage S. Combined Additional—caused by (Continued on Page 2) C-11385 EDITION OCT. 1, 1966 PRINTED IN U.S.A. N.S. (PHD) (GA-158 8 GA-159) 367 • L16 AUTOMOBILE PHYSICAL DAMAGE INSURANCE COVERAGE PART Page 2 3. Supplementary Payments II. Limit of Liability In additional to the applicable limits of liability, the corn- 1. The limit of the company's liability for loss to any one pany will: covered automobile shall not exceed the least of the (a) with respect to such transportation insurance as is af- following amounts: forded herein, pay general average and salvage charges (a) the actual cash value of such covered automobile, or for which the named insured becomes legally liable; if the loss is to a part thereof the actual cash value (b) reimburse the named insured, in the event of a theft of such part, at time of loss; or covered by this insurance of an entire covered auto- (b) what it would then cost to repair or replace such mobile of the private passenger type (not used as a covered automobile or part thereof with other of like public or livery conveyance and not, at time of theft, kind and quality, with deduction for depreciation; or being held for sale by an automobile dealer), for ex- (c) the limit of liability stated in the declarations as pense incurred for the rental of a substitute for such applicable to "each covered automobile" under the covered automobile during the period commencing 48 coverage afforded for the loss to such covered auto- hours after such theft has been reported to the corn- mobile, provided that if such limit of liability is ex- pany and the police and terminating, regardless of ex- pressed as a stated amount it shall, with respect to piration of the policy period, when such covered auto- a covered automobile newly acquired during the mobile is returned to use or the company pays for the policy period and not described in the declarations, loss; but, as to any one such theft, such reimburse- be deemed as having been replaced by "actual cash ment shall not exceed $10 for any one day nor $300 value"; total. and (if this insurance is stated in the schedule as being 4. Such insurance as is afforded under each coverage applies "Fleet Automatic"), subject to the above provisions, separately to each covered automobile, and a land motor shall not in any event exceed the amount, if any, stated vehicle and one or more trailers or semitrailers attached in the schedule as the "maximum limit of liability" thereto shall be held to be separate covered automobiles applicable to "any one covered automobile." as respects limits of liability and any deductible pro- 2. If this insurance is stated in the schedule as being visions applicable thereto. "Fleet Automatic", the total limit of the company's Exclusions liability for all loss directly attributable to a single This insurance does not apply: happening out of which loss occurs shall not exceed: (a) to any covered automobile while used as a public or (a) as to all covered automobiles at any one location, livery conveyance, unless such use is specifically de- the amount, if any, stated in the schedule as the Glared and described in the declarations; "maximum limit of liability" applicable thereto, (b) to damage which is due and confined to: subject to the above provisions respecting any one covered automobile; (i) wear and tear, or (b) as to all covered automobiles, the amount, if any, (ii) freezing, or stated in the schedule as the "maximum limit of (iii) mechanical or electrical breakdown or failure, liability" applicable thereto, subject to the above unless such damage is the result of other loss covered provisions respecting (i) any one covered automobile by this insurance; and (ii) any one location. (c) to tires, unless Ill. Policy Period; Territory; Purposes of Use (i) loss be coincident with and from the same cause as This insurance applies only to loss which occurs during other loss covered by this insurance; or the policy period, while the covered automobile is within (ii) damaged by fire (and, if a covered automobile of the the United States of America, it territories or possessions, private passenger type, by malicious mischief or or Canada, or is being transported between ports thereof vandalism) or stolen and, as to the covered automo- and, if a covered automobile described in the declarations, bile, loss caused by such damage or theft is covered is maintained and used for the purposes stated therein as by this insurance; applicable thereto. (d) to loss due to IV. Additional Definitions (i) war, whether or not declared, civil war, insurrection, When used in reference to this insurance (including en- rebellion or revolution, or to any act or condition in- dorsements forming a part of the policy): cident to any of the foregoing; "collision" means (i) collision of a covered automobile (ii) radioactive contamination; with another object or with a vehicle to which it is at- tached, or (ii) upset of such covered automobile; (e) under the Comprehensive and Theft coverages, to loss or damage due to conversion, embezzlement or secretion by "commercial type"means (if this insurance is stated in the any person in possession ofa covered automobile under schedule as being "Fleet Automatic") a bailment lease, conditional sale, purchase agreement, (i) a land motor vehicle of the truck, pick-up, express, mortgage or other encumbrance; sedan or panel delivery type, including truck-type (f) under the Collision coverage, to breakage of glass if tractors, trailers and semitrailers, used for the trans- insurance with respect to such breakage is otherwise portation or delivery of goods or merchandise or for afforded herein; other business purposes, or • (g) under the Combined Additional coverage, to loss resulting (ii) an altered private passenger type vehicle used for retail from rain, snow or sleet, whether or not wind-driven. or wholesale delivery; L16 (Continued on Page 3) Page 3 "covered automobile" means a land motor vehicle, trailer or bution or indemnity against any person or organi- semitrailer, including its equipment and other equipment zation who may be liable to the named insured be- permanently attached thereto (but not including robes, wear- cause of loss with respect to which this insurance ing apparel or personal effects), which is either applies; and shall attend hearings and trials and (a) designated in the declarations, by description or other- assist in securing and giving evidence and obtaining wise, as a covered automobile to which this insurance the attendance of witnesses; applies and is: but the named insured shall not, except at his own cost, (i) owned by the named insured, or voluntarily make any payment, assume any obligation, Gil (if this insurance is stated in the schedule as being offer or pay any reward for recovery of stolen property or incur any expense other than as specifically provided in "Fleet Automatic") leased to the named insured for this insurance. a term of not less than one year under an agreement expressly prohibiting any right of the lessor or owner 2. Payment for Loss to use such vehicle during the term of such lease With respect to any loss covered by this insurance, the except either as an operator employed by the named company may pay for said loss in money, or may: insured or for its repair or exchange; or (a) repair or replace the damaged or stolen property, or (b) if not so designated, such vehicle is newly acquired by (b) return at its expense any stolen property to the named the named insured during the policy period provided, insured, with payment for any resultant damage thereto, however, that: at any time before the loss is so paid or the property (i) it replaces a described covered automobile, or as of is so replaced, or the date of its delivery this insurance applies to all (c) take all or any part of the damaged or stolen property covered automobiles, and at the agreed or appraised value, (ii) the named insured notifies the company within 30 but there shall be no abandonment to the company. days following such delivery date; 3. Appraisal but "covered automobile" does not include a vehicle owned If the named insured and the company fail to agree as to by or registered in the name of any individual partner or the amount of loss, either may, within 60 days after proof executive officer of the named insured, unless specifically of loss is filed, demand an appraisal of the loss. In such stated otherwise by endorsement forming a part of the policy; event the named insured and the company shall each "loss" means direct and accidental loss or damage; select a competent appraiser, and the appraisers shall select a competent and disinterested umpire. The ap- "private passenger type" means a 4-wheel land motor vehicle praisers shall state separately the actual cash value and of the private passenger or station wagon type; the amount of loss and failing to agree shall submit their as to "purposes of use": differences to the umpire. An award in writing of any two "commercial" means use principally in the business oc- shall determine the amount of loss. The named insured cupation of the named insured as stated in the schedule, and the company shall each pay its chosen appraiser and including occasional use for personal, pleasure, family shall bear equally the other expenses of the appraisal and . and other business purposes; umpire. "pleasure and business" means personal, pleasure, family The company shall not be held to have waived any of its and business use. rights by any act relating to appraisal. V. Conditions 4. Action Against Company None of the Conditions of the policy shall apply to this No action shall lie against the company unless, as a con- insurance except "Premium", "Inspection and Audit", "Sub- dition precedent thereto, there shall have been full corn- rogation", "Changes", "Assignment", "Three Year Policy", pliance with all the terms of this insurance nor until 30 "Cancellation", and "Declarations". This insurance shall days after proof of loss is filed and the amount of loss also be subject to the following additional Conditions: is determined as provided in this insurance. 1. Named Insured's Duties in Event of Loss 5.Other Insurance In the event of loss the named insured shall: If the named insured has other insurance against a loss covered by this insurance, the company shall not be (a) protect the covered automobile, whether or not this liable under this insurance for a greater proportion of insurance applies to the loss, and any further loss or such loss than the applicable limit of liability stated in damage due to the named insured's failure to protect the declarations bears to the total applicable limit of shall not be recoverable under this insurance; reason- liability of all valid and collectible insurance against such able expenses incurred in affording such protection loss; provided, however, with respect to any covered auto- shall be deemed incurred at the company's request; mobile newly acquired during the policy period and not (b) give notice thereof as soon as practicable to the com described in the declarations, this insurance shall not pany or any of its authorized agents and also, in the apply to any loss against which the named insured has event of theft or larceny, to the police; other valid and collectible insurance. (c) file with the company, within 91 days after loss, his 6. No Benefit to Bailee sworn proof of loss in such form and including such None of the provisions of this insurance shall inure di- information as the company may reasonably require rectly or indirectly to the benefit of any carrier or other and, upon the company's request, shall exhibit the bailee for hire. damaged property and submit to examination under oath; 7.Terms of Insurance Conformed to Statute (d) cooperate with the company and, upon the company's Terms of this insurance which are in conflict with the request, shall assist in making settlements, in the statutes of the state wherein this insurance is issued are conduct of suits and in enforcing any right of contri- hereby amended to conform to such statutes. C-11385 EDITION OCT. 1, 1966 PRINTED IN U.S.A. N.S. (PHD) (GA-158 & GA-159) 367 L16 • HOSPITAL PROFESSIONAL LIABILITY INSURANCE COVERAGE PART p ADDITIONAL DECLARATIONS Forming part of Policy No. NSL 2373678 Coverage Limits of Liability Advance Premium O. Hospital Professional Liability $ 300,000 each claim $ 168 $ 500,000 aggregate $ Total Advance Premium $ 168 General Liability Hazards Description of Hazards(State Name;whether operated not-for-profit;Kind of cared for; Advance School of Medicine in charge) Code No. Premium Bases Rates Premiums A-Beds A-Each B-Out-Patients B-Per$100 Visits CONVALESCENT OR NURSING HOMES - NOT MENTAL - PSHYCO- PATHIC INSTITUTION GOVERNMENTAL MINIMUM PER BED 5428 A-97 3.36 168 Minimum Premium Per Location per Annum$ (Continued on Page 2) L 22 Page 2 I. COVERAGE 0—HOSPITAL PROFESSIONAL LIABILITY ♦ II. PERSONS INSURED The company will pay on behalf of the insured all sums Each of the following is an insured under this insurance which the insured shall become legally obligated to pay as to the extent set forth below: damages because of injury to any person arising out of the (a) the named insured; rendering of or failure to render,during the policy period, (b) if the named insured is designated in the declara- the following professional services: tions as a partnership, any partner or member thereof, but only with respect to his liability as (a) medical, surgical, dental or nursing treatment to such person or the person inflicting the injury in- such; cluding the furnishing of food or beverages in con- (c) if the named insured is designated in the declara- nection therewith, tions as other than an individual or partnership, any executive officer, stockholder or member of (b) or surgical dispensing of drugsor medical,dental the board of trustees, directors or governors of the or o supplies s named insured ndc has if the injury i named insured while acting within the scope of his occurs after the relinquished duties as such. possession thereof to others, (c) handling of or performing post-mortem examina- III. LIMITS OF LIABILITY bons on human bodies, or Regardless of the number of insureds under this insur- (d) service by any person as a member of a formal ance the company's liability is limited as follows: accreditation or similar professional board or The limit of liability stated in the declarations as ap- committee of the named insured, or as a person plicable to "each claim" is the limit of the company's charged with the duty of executing directives of liability for all damages because of each claim or suit any such board or committee, covered hereby. The limit of liability stated in the de- and the company shall have the right and duty to defend clarations as "aggregate" is, subject total above efp tho- e suit against the insured seeking such damages, even vision respecting "each claim", if any of the allegations of the suit are groundless, false company's liability hereunder for all damages. or fraudulent, and may make such investigation and, with the written consent of the insured, such settlement IV. AMENDED DEFINITION of any claim or suit as it deems expedient, but the com- When used in reference to this insurance "damages" pany shall not be obligated to pay any claim or judg- means all damages, including damages for death, which ment or to defend any suit after the applicable limit of are payable because of injury to which this insurance the company's liability has been exhausted by payment applies. of judgments or settlements. V. ADDITIONAL CONDITIONS _ A. Insured's Duties in the Event of Injury,Claim or Suit When an Exclusions injury occurs written notice shall be given by orl on j This insurance does not apply: behalf of the insured, in accordance with the "In- (a) to bodily injury to any employee of the insured sured's Duties in the Event of Occurrence, Claim or arising out of and in the course of his employment Suit" Condition. by the insured; — _ B. First Aid Exclusion The insurance shall not apply to (b) to any obligation for which the insured or any expenses incurred by the insured for first aid at the carrier as his insurer may be held liable under any time of an accident and the "Supplementary Pay- workmen's compensation, unemployment com- ments" provision and the "Insured's Duties in the pensation or disability benefits law, or under any Event of Occurrence, Claim or Suit" Condition are similar law; amended accordingly. (c) to liability of an insured, if an individual, for his C. Limitation of Coverage Under Any Other Liability Insurance personal acts or omissions of a professional nature; Except as stated in this Part, the policy does not (d) to the ownership, maintenance, operation, use, apply to injury arising out of the rendering of or failure loading or unloading of any motor vehicle, trailer, tar I render er the professional services described in para- watercraft or aircraft. • grJ I L 2 C-11540 Edition October I,1966 PRINTED IN U.S.N. N.F.(HPL) Hello